Preoperative FEV1 Research Articles

Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage, recovery, complications, and prognosis in video-assisted thoracic surgical lobectomy: a randomized, double-blinded, placebo-controlled trial.

Transcutaneous electrical acupoint stimulation (TEAS), a non-invasive and non-pharmacological adjunctive intervention for perioperative analgesia, may also reduce the incidence of postoperative pulmonary complications. The effect of TEAS on video-assisted thoracic surgical (VATS) patients is still unknown, however. The purpose of this study was to investigate the effects of TEAS of different frequency on perioperative anesthetic dosage, recovery, complications, and prognosis for patients undergoing VATS lobectomy. Eighty VATS lobectomy patients with no previous experience of TEAS or acupuncture were randomly assigned to four groups: control (con), 2/100, 2, and 100Hz. The last three experimental groups received TEAS at the indicated frequencies for 30min before induction, during the operation, and for another 30min 24 and 48h after surgery. 2/100Hz is a type of alternating frequency which goes between 2 and 100Hz every 3s. TEAS was administered over acupoints Neiguan, Hegu, Lieque, and Quchi on the sick lateral. Electrodes were applied to the patients in the control group, but no TEAS was used. Anesthetic dosage, blood gas analysis results, lung function indexes FEV1 and FVC, post-anesthesia care unit (PACU) status, postoperative complications, and quality of life scores were recorded and analyzed statistically. Intraoperative opioid consumption was lowest in the 2/100Hz group, with statistical significance (con, P≤0.001; 2Hz, P≤0.001; 100Hz, P=0.026). Compared with preoperative FEV1 and FVC, postoperative FEV1 and FVC were significantly lower in all groups; during one-lung ventilation, arterial oxygen partial pressure (PaO2) decreased more slowly in the 2/100Hz group than in the con group (P=0.042). Moreover, in the 2/100Hz group extubation time was shorter (P=0.038), visual analgesia scale score lower (P=0.047), and duration of PACU stay shorter (P=0.043) than in the con group. In the 100Hz group incidence of postoperative nausea and vomiting (PONV) was lower than the con group (P=0.044). In all groups mean postoperative physical component scores were significantly lower than mean preoperative scores. TEAS is a safe noninvasive adjunctive intervention for anesthesia management among patients undergoing VATS lobectomy. TEAS at 2/100Hz can reduce intraoperative opioid dosage and slow the decrease of PaO2 during one-lung ventilation. It can also effectively reduce pain score, extubation time, and PACU stay immediately after surgery. Further, 100Hz TEAS can reduce PONV morbidity.

Resultados de la cirugía de resección pulmonar sobre pulmón único

BackgroundAfter pneumonectomy, the development of a new lung cancer or a recurrence in the residual lung is a challenge. Surgery often is considered contraindicated. The goal of our study is to assess the morbidity and mortality of lung resection on a single lung. MethodsAll patients who underwent lung resection after pneumonectomy from January 1996 through December 2012 were reviewed. ResultsThere were 12 patients (10 men and 2 women). Mean age was 71 years (range, 54-81 years). Mean preoperative FEV1 was 1470ml (52%) and preoperative FVC 2153ml (61,5%). Subsequent pulmonary resection was performed after a median follow-up of 34,5 months. Wedge resection was performed in all patients. Diagnosis was pulmonary mestastatic lung cancer in 2 patients, metachronous lung cancer in 6, metastatic extrathoracic cancer in 3 and benign nodule in one. Complications occurred in 4 patients (33,4%) while operative mortality was nil. ConclusionsLung resection on a single lung is a safe procedure associated with acceptable morbidity and mortality. Careful patient selection is very important.

Prognostic implication of pulmonary function at the beginning of postoperative radiotherapy in non-small cell lung cancer

PurposeThe purpose of this study was to investigate the prognostic effect of pulmonary function at the beginning of postoperative radiotherapy (PORT) in non-small cell lung cancer (NSCLC). Materials and methodsFrom January 2002 to December 2012, 115 patients with NSCLC who underwent PORT and took the forced expiratory volume in 1 second (FEV1) at the beginning of PORT were analysed. PORT began within 4–6weeks following surgery, and the 3-dimensional conformal technique was used with conventional fractionation. The high and low FEV1 groups were divided by the median absolute value of FEV1 at the beginning of PORT, and we compared the clinical factors and survival between two groups. ResultsThe median absolute value of FEV1 at the beginning of PORT was 1.68L (range, 0.83–3.89), and patients were divided into low and high FEV1 groups (<1.68L versus ⩾1.68L). Patients in the low FEV1 group showed a lower preoperative FEV1 (mean, 1.94L versus 2.73L, p<0.001) and received more pneumonectomy (36.8% versus 8.6%, p<0.001) compared to the high FEV1 group. The overall median follow-up time was 31months (range, 3–110), and 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were 52.4%, 48.9%, and 45.9%, respectively. Five-year OS of the low FEV1 group was significantly lower than that of the high FEV1 group (35.4% versus 56.9%, p=0.002), and no significant differences were found in LRRFS and DMFS. In a multivariate analysis, the difference of OS between the low and high FEV1 groups remained significant (Hazard Ratio=2.04, CI, 1.18–3.55, p=0.011). ConclusionsThe FEV1 at the beginning of PORT was an independent significant prognostic factor in patients with NSCLC who received PORT. Considering this analysis was limited to only patients receiving PORT, further studies are warranted to compare the survival effect of postoperative pulmonary function between groups with/without PORT.

From open surgery to uniportal VATS: asturias experience.

Uniportal video-assisted thoracic surgery (VATS) resections are of increasing interest in many thoracic surgery departments. This study shows our initial experience in uniportal VATS anatomical resections in direct transition from posterolateral thoracotomy. We retrospectively reviewed the 82 files of patients on whom anatomical pulmonary resection via uniportal VATS was attempted in our department by a single surgeon experienced in VATS for almost all purposes except major pulmonary resections. Demographic data of patients, smoking habits, chronic obstructive pulmonary disease (COPD), presence of cardiopulmonary comorbidities, general characteristics of pulmonary lesions, preoperative FEV1, intraoperative findings, operative time, postoperative-drain-time, hospital-stay-time, successfully completed or converted to thoracotomy, intraoperative and postoperative complications and 30-day mortality were recorded. The patients were chronologically divided into two groups for analysis (A: operated on in the first year; B: operated on after the first year). We compare our results with the largest published experience in anatomical resections by uniportal VATS started from multiport technique and anterior thoracotomy in order to identify the feasibility of this transition. From January 2012 to January 2014, 82 uniportal VATS anatomical pulmonary resections were attempted. Of these 82 resections attempted, 74 (90.2%) were completely carried out. The median drain-time and hospital-stay-time were 3 days, and 4 days for the first year of experience and 2 and 3 days for the second year of experience respectively. The most frequent intraoperative complication was bleeding in 10 (12.1%), of these 8 occurred in the first year of experience (group A). In 8 (9.75%) cases conversion to thoracotomy widening the incision was needed for different reasons, of these 6 occurred in group A. The most frequent minor complication was chest tube reinsertion in 12 (14.6%) patients. There were no major complications or mortality in the first year of experience (group A). Two cases of mortality in the 8(th) and 15(th) postoperative day respectively occurred in group B in two patients with serious comorbidities. Uniportal VATS for anatomical resections is a feasible and safe technique with good results even if experience is started in direct transition from open surgery, on condition that general recommendations for an initial VATS program were observed. Specific training courses with experts are also necessary. Patient selection is crucial. The number of procedures necessary to obtain appropriate experience may be similar to those reported for transition from open surgery to multiport technique.

Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis: Measured by computed tomography.

Background:Change in total lung volume after surgical correction in adolescent idiopathic scoliosis (AIS), measured by computed tomography (CT), has not been studied previously. The primary objective of this study was to measure the change in lung volume between pre and postoperative AIS using low-dose CT and secondary objective was to investigate its relationship to postoperative pulmonary complications.Materials and Methods:55 AIS patients underwent surgery for correction and fusion using a posterior only approach and pedicle screws. Pre and postoperative lung volumes were measured using a 3-dimensional (3D) whole spine CT (low dose protocol: Tube current, 60 mA; tube voltage 120 kV). Postoperative low dose CT was undertaken at 4 weeks after operation to evaluate the acute changes of postoperative lung volumes and pulmonary complications. The software that was used recognizes the “air density shade” of the lung and the volume of every section of the lung. The software then automatically calculates total lung volume by summation of all section volumes. The relationships between postoperative pulmonary complications and changes in lung volume on low dose CT as well as preoperative forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were calculated using logistic regression analysis.Results:There was a decrease of 12% ± 23.2% in total lung volume postoperatively on 3D low dose CT (P < 0.001). Thirteen patients had increased lung volume while 42 had decreased lung volume postoperatively. Pulmonary complications were treated without severe sequale. Lung volume increased by 19.65% ± 19.84% in 13 patients and decreased by 21.85% ± 13.32% in 42 patients (P = 0.647). Lung volume was increased in patients whose preoperative lung volume, FEV1 and FVC were lower than in patients whose values were higher (r = −0.273, −0.291 and − 0.348; P = 0.044, 0.045 and 0.015, respectively). Postoperative lung volume was also increased when intraoperative fluid administration was larger and operative time was longer (r = 0.354, 0.417 and P = 0.008, 0.002, respectively). There was a statistically significant negative correlation in the change of lung volume in female patients when compared with male patients (r = −0.294, P = 0.03).Conclusion:Patients with AIS who have preoperative reduced lung volumes or lung functions can achieve further increased lung volume after surgical correction. Pulmonary complications during perioperative period were mostly treated with proper management without severe sequale. Therefore, although surgery for AIS is considered to be a high risk procedure, we can recommend to correct spine deformity in patients with severe AIS in order to improve lung function and long term prognosis.

Improved prediction of lobar perfusion contribution using technetium-99m–labeled macroaggregate of albumin single photon emission computed tomography/computed tomography with attenuation correction

Lung cancer resection can require removal of an entire lobe and, at times, bilobectomy or pneumonectomy. Many patients will also have significantly compromised lung function that requires limiting the extent of surgery or could preclude surgery altogether. The preoperative assessment should include predicted postoperative forced expiratory volume in 1 second (ppoFEV1), because a ppoFEV1 of <40% predicts significantly increased perioperative morbidity. The ppoFEV1 can be estimated by multiplying the preoperative FEV1 by the residual perfused territory percentage, as predicted on planar perfusion scintigraphy (PPS). However, ppoFEV1 using PPS has shown variable correlation with spirometry-measured postoperative FEV1. We propose an improved method for assessing regional lung perfusion in preoperative lung surgery patients. Patients undergo single photon emission computed tomography/computed tomography (SPECT/CT) imaging with attenuation correction using the conventional perfusion agent, technetium-99m-labeled macroaggregate of albumin. The CT image provides information for manual segmentation of each lobe. These segmentations are applied to the SPECT images to determine lobar perfusion. This proposed method was compared with PPS. This technique was evaluated in 17 patients. As expected, the perfusion contributions of the right and left lungs, calculated from SPECT/CT, correlated closely with those obtained from PPS (Pearson r=0.995). However, the lobar perfusion contributions obtained by PPS and SPECT/CT were significantly different, by 2 methods of comparison (Hotelling's P=1.7×10(-6) and P=1.7×10(-4)). This new SPECT/CT technique provides an anatomically more accurate assessment of lobar perfusion. This technique can refine which patients should be operative candidates and allow better prediction of postoperative function in contrast to the anatomically inaccurate planar scintigraphic predictions, which often underestimate the postoperative FEV1. This new technique is expected to have a significant effect on the resectability of patients with lung cancer.

A retrospective study of diaphragmatic motion, pulmonary function, and quality-of-life following video-assisted thoracoscopic lobectomy in patients with nonsmall cell lung cancer.

Diaphragmatic dysfunction and its negative physiologic disadvantages are less commonly reported in patients with lung cancer video-assisted thoracoscopic lobectomy. The aim of this study was to investigate the outcomes of this complication on pulmonary function and quality-of-life in patients following video-assisted thoracoscopic lobectomy. The aim of this study was to investigate potential benefits on pulmonary function and quality-of-life with normal diaphragmatic motion. A retrospective study was conducted in 64 patients with nonsmall cell lung cancer after video-assisted thoracoscopic lobectomy. The population were divided into groups 1 (with diaphragmatic paralysis, n = 32) and group 2 (without diaphragmatic paralysis, n = 32) according diaphragmatic motion after postoperatively 6 months. And then, we investigated the difference between the two groups on pulmonary function and quality-of-life. (1) At 6 months after resection, the patients in group 1 had lost 25% of their preoperative forced expiratory volume in the 1 s (FEV 1 ) (P < 0.001), and the patients in group 2 had lost 15% of their preoperative FEV 1 (P < 0.001). And the other spirometric variables in group 1 were significantly worse than that of group 2 (P < 0.001). (2) The most frequently reported postoperative symptoms were fatigue, coughing, dyspnea, and thoracotomy pain in two groups. Of all the symptom scales, only the dyspnea scale showed a significant difference which subject has a higher proportion and scale compared to control. The present study indicates that unilateral diaphragmatic paralysis following video-assisted thoracoscopic lobectomy caused adverse effects on postoperative pulmonary function and quality-of-life.

Video-assisted thoracoscopic lobectomy for non-small cell lung cancer in patients with severe chronic obstructive pulmonary disease.

To assess the feasibility, safety and long-term outcomes of video-assisted thoracic surgery (VATS) lobectomy for the treatment of non-small cell lung cancer (NSCLC) in patients with severe chronic obstructive pulmonary disease (COPD). The clinical data of patients with NSCLC and severe COPD (preoperative FEV1% <50%) who underwent VATS lobectomy from January 2000 to January 2011 were retrospectively analyzed to identify their demographic parameters, postoperative complications and outcomes. The preoperative FEV1/FVC was <70% and FEV1% <50% in all 61 patients in this study, with a mean preoperative FEV1 of 0.99 L (0.54-1.58 L) and mean FEV1% of 38.4% (22-49.82%). All of the 61 patients underwent the VATS lobectomy or sleeve resection plus systemic lymph node dissection. The mean operative time was 218 minutes (120-355 minutes), with a mean intraoperative blood loss of 342 mL (50-1,600 mL). None of the patients converted to thoracotomy. Multivariate statistical analysis revealed that age and TNM staging after tumor resection were independent predictive factors for the 5-year survival in those patients (P=0.014 and 0.013). With preoperative imaging studies, pulmonary function assessment and target positioning, VATS lobectomy can be safely and effectively performed for patients with NSCLC and severe COPD to achieve a satisfying long-term survival outcome.

Pulmonary function after less invasive anterior instrumentation and fusion for idiopathic thoracic scoliosis

PurposeStandard thoracotomy for anterior instrumentation and fusion of the thoracic spine in idiopathic scoliosis may have detrimental effects on pulmonary function. In this study we describe a less invasive anterior surgical technique and show the pre- and postoperative pulmonary function with a minimum follow-up of 2 years.MethodsTwenty patients with Lenke type 1 adolescent thoracic idiopathic scoliosis were treated with anterior spinal fusion and instrumentation. The mean preoperative Cobb angle of the thoracic curve was 53° ± 5.8. Pulmonary function tests (PFT) and radiographic evaluation was performed.ResultsThe mean postoperative correction in Cobb angle of the thoracic curve was 27° ± 8.2 (49%).The mean preoperative FEV1 was 2.81 ± 0.43 L, which increased to 3.14 ± 0.50 L at 2 years postoperatively (P = 0.000). The mean FEV1% did not change (89.60 ± 7.49% preoperatively, versus 90.53 ± 5.95% at 2 years follow-up, P = 0.467). The TLC increased from 4.62 ± 0.62 L preoperatively to 5.17 ± 0.63 L at 2 years follow-up (P = 0.000). The FEV1% at two years of follow-up improved to 104% of the FEV1% predicted value. The FEV1 improved to 97% of the FEV1 predicted value.ConclusionAnterior spinal fusion for idiopathic scoliosis by means of a minimal open thoracotomy proved to be a safe surgical technique that resulted in an improvement of pulmonary function. Our results are similar to those of thoracoscopic procedures reported in literature.

Prediction of Postoperative Lung Function in Patients Undergoing Lung Resection

The purpose of this study was to assess the usefulness of dual-energy perfusion computed tomography (CT) for predicting postoperative lung function in patients undergoing lung resection. Fifty-one patients (38 men, 13 women; mean age, 63.8 years) were prospectively enrolled and subsequently underwent dual-energy CT, perfusion scintigraphy, a pulmonary function test before surgery, and a pulmonary function test 6 months after surgery. Computed tomography was performed using dual-source CT with the dual-energy technique. Using weighted average images, each lobe was segmented and using perfusion images, the iodine value was quantitatively measured. Lobar perfusion was calculated by multiplying the volume of the lobe by the iodine value. The ratio of lobar perfusion per whole-lung perfusion was then calculated. The predicted postoperative forced expiratory volume during 1 second (post-FEV1) was calculated by multiplying the preoperative FEV1 by the fractional contribution of perfusion of the remaining lung. The agreement between the predicted post-FEV1 and the actual post-FEV1 was then evaluated. The percentage of error of the predicted post-FEV1 to that of the actual post-FEV1 was then calculated. Using the Bland-Altman method, the limits of agreement between the actual post-FEV1 and the predicted post-FEV1 were -29.3% and 26.9% for scintigraphy and -28.9% and 17.3% for CT. The percentage of error of CT (15.4%) was comparable with that of scintigraphy (17.8%). Dual-energy perfusion CT was more accurate than perfusion scintigraphy was for predicting postoperative lung function.

Predictive factors for complications of anatomical pulmonary segmentectomies

The role of anatomical pulmonary segmentectomy is increasing, but there are few data about its complication rate. We have analysed the postoperative morbidity, mortality and risk factors in a consecutive series of 228 segmentectomies performed in our department. Between January 2007 and December 2011, 221 patients underwent 228 segmentectomies. There were 99 women (45%) and 122 men (55%). The mean age was 61 years (range 18-86 years). The mean forced expiratory volume in 1 s (FEV1) was 87%, and 30 patients had an FEV1 of ≤60%. Fifty-seven patients had a previous history of pulmonary resection. Indications for segmentectomy were: primary lung cancer (111 cases), metastases (71 cases), benign non-infectious (25 cases) and benign infectious diseases (21 cases). The approach was a posterolateral thoracotomy (Group PLT) in 146 patients (64%) and a thoracoscopy (Group TS) in 82 (36%). The two groups were homogenous in terms of age, gender, indications of surgery and type of segmentectomy. The mortality rate at 3 months was 1.3% (3 patients). The overall complication rate was 34%. Ten patients were reoperated for the following reasons: haemothorax (4 cases), ischaemia of the remaining segment (3 cases), active bleeding (1 case), prolonged air leak (1 case) and dehiscence of thoracotomy (1 case). The average duration of drainage was 5 days (range 1-34 days) and the average length of stay was 9 days (range 3-126 days). On univariate analysis, FEV1, male gender and thoracotomy were statistically significant risk factors for complications. On multivariate analysis, the same three predictive factors of complications independently of age were found statistically significant: preoperative FEV1 < 60% [odds ratio (OR) = 5.9, 95% CI (2.5-13.7), P < 0.001] male gender [OR = 2.04, 95% CI (1.2-3.6), P < 0.013] and thoracotomy [OR = 2.14, 95% CI (1.33-3.46), P = 0.001]. Pulmonary anatomical segmentectomies have an acceptable morbidity rate. Postoperative complications are more likely to develop in male gender patients, with FEV1 ≤ 60% and operated by open surgery.

P-215QUANTITATIVE ASSESSMENT OF EMPHYSEMATOUS PARENCHYMA USING MULTIDETECTOR-ROW COMPUTED TOMOGRAPHY IN PATIENTS SCHEDULED FOR ENDOBRONCHIAL TREATMENT WITH ONE-WAY VALVES

Quantitative chest-tomography assessment of emphysema represents a valid tool to evaluate parenchymal hyperinflation in emphysematous patients. We aimed to investigate if the quantitative assessment (global lung and/or target lobe) of emphysematous parenchyma using multidetector-row computed tomography (MDCT) may improve the selection of patients scheduled for bronchoscopic lung volume reduction (BLVR). Fifteen patients underwent BLVR using endobronchial-one-way valves in the last five years. All patients were studied pre- and postoperatively with MDCT chest scan and fitness tests. Emphysematous parenchyma was obtained applying density thresholds of -1.024/-950 HU. The differences between preoperative and postoperative radiological findings were statistically compared (Mann-Whitney test) and plotted against spirometric results (Spearman test) observed three months after the procedure. Radiological findings showed the presence of giant empysematous bullae associated with heterogeneous emphysema (n = 9) and heterogeneous emphysema alone (n = 5). Regarding the preoperative value, the postoperative volume of global lung (1876 vs 1493; P = 0.001) and of the target lobe (1626 vs 1049; P < 0.0001) was significantly reduced. Volumetric median reduction of global lung and of target lobe was 24% [66%-0.3%] and 26% [100%-0.9%], respectively. As regards to preoperative data, FEV1 (46% vs 38%; P = 0.02), and FVC postoperative value (51% vs 42%; P = 0.02) were significantly increased, while RV postoperative value (189% vs 153%; P = 0.0001) was significantly reduced. Significant correlation existed between the increase in FEV1 and the reduction in volume of global lung (r = -0.77; P = 0.0008; 95% CI: -0.920 to -0.42) and of target lobe (r= -0.6; P = 0.004; 95% CI: -0.850 to -0.28). Our study showed a significant correlation between the volume reduction of emphysema measured using MDCT and the improvement of FEV1. Considering the costs of valves, the MDCT quantification of emphysema may be used in preoperative work-up to select patients who will benefit or not from BLVR with cost saving. All authors have declared no conflicts of interest.

Effects of Hyperglycemia on Primary Graft Dysfunction in Lung Transplantation

Purpose Primary graft dysfunction (PGD) is a significant source of morbidity and mortality. Hyperglycemia is associated with ischemia-reperfusion in mouse models of lung transplant. We hypothesized that perioperative hyperglycemia is associated with grade 3 PGD. Methods and Materials A retrospective review was performed of 125 patients undergoing lung transplant from 2008-2012. The highest blood glucose was recorded preoperatively, intraoperatively, and for 14 days postoperatively. Glucose >160 mg/dL was considered hyperglycemic. PGD was defined as a PaO2/FiO2 ratio Results The incidence of PGD was 16.8% (n=21). Hyperglycemia occurred in 90.4% (n=113) within 48 hours post-transplant while 8% had severe hyperglycemia (>300mg/dL). On univariate and logistic regression analyses, neither the presence nor the degree of hyperglycemia was associated with PGD. However, in a multivariate logistic regression model, preoperative supplemental oxygen (OR 1.24, 95% CI 1.01-1.52, p=0.037) and a low preoperative FEV1 (OR 3.11, 95% CI 1.06-9.15, p=0.040) were risk factors for the development of PGD. On multivariate analysis of secondary outcomes, lactate above 3 mg/dL (HR 1.9, 95% CI 1.24-2.82, p=0.003) and days on an insulin drip (HR 1.11, 95% CI 1.04-1.16, p Conclusions Hyperglycemia occurs frequently in the post-transplant period but was not associated with PGD. Poor preoperative pulmonary function and oxygen use were most significantly associated with PGD while increased days on an insulin drip and high lactate were associated with increased days on mechanical ventilation. These results suggest a group of patients who are more likely to develop PGD and require prolonged ventilatory support in the post-transplant period.

Reconstruction with fascia lata after extensive chest wall resection: results

Following extensive chest wall resection, the reconstruction technique should fulfill two opposing functional requirements: adequate rigidity and flexibility of the chest wall during the breathing phases. Reconstruction with fascia lata enables a balance between these two parameters, thus favouring the patients' respiratory dynamics and producing low morbidity and good functional results. Sixty patients underwent chest wall reconstruction using fascia lata alone or in combination with titanium plates between 2006 and 2011, due to primary tumours in 28 patients, metastases in 23 and local recurrences in 9. The mean area of resected tissue was 107.7 cm(2), distributed among the anterior, anterolateral, lateral and posterior zones. One-to-eight ribs were resected, and additional sternum resection was performed in 75% of patients. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated in 33 patients. 46.6% of patients underwent reconstruction with fascia lata alone, 1.6% with fascia lata, DualMesh® and titanium plates and 51.6% with fascia lata and titanium plates. There was no 30-day mortality. All patients were extubated after the operation with no need for reintubation. Five patients had postoperative complications: 2 wound dehiscences, 2 haematomas and 1 seroma. There were no significant differences between preoperative and postoperative FEV1 and FVC measurements in patients with or without lobectomy and wedge resections. Chest wall reconstruction with fascia lata, alone or in combination with titanium plates, allows the surgeon to perform a dynamic reconstruction without flail chest in extensive exeresis. Risks of infection associated with the use of prosthetic materials are also minimized. In addition, the characteristic flexibility of this tissue makes it a precious tool in paediatric chest wall reconstruction, since fascia lata naturally adapts to the physiological growth of younger bodies, thus reducing the risk of scoliosis and local deformities.

AB 17. Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection

Lung resection is still the only potentially curative therapy for patients with localised non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbities and known underlying lung disease increase the risk of perioperative death and postoperative complications. Various studies have evaluated the use of different preoperative tests with aim to identify patients with impaired pulmonary function at greater risk for complications. Postoperative complications are associated with prolonged hospital stays and excessive morbidity and mortality especially in this group of patients. According to the ACCP/BTS guidelines, patients without known underlying lung disease with a preoperative FEV1 in excess of 2 L, generally tolerate pneumonectomy whereas those with FEV1 greater that 1.5 L, tolerate lobectomy. Although spirometric values strongly correlate with the severity of obstruction, they do not provide direct information regarding the degree of gas exchange impairment that is often present and the cardiovascular function. Cardiopulmonary exercise testing (CPET) is considered among the preoperative tests suggested before lung resection for patients with known underlying cardiovascular or lung disease. CPET is based on the interactions among the pulmonary function, the cardiovascular function and the oxygen absorption from the peripheral tissues. Patients with maximal oxygen consumption (VO2 max) <10 mL/kg/min or those with VO2 max <15 mL/kg/min and both postoperative FEV1 and DLCO <40% predicted are considered to be at high risk for perioperative death and cardiopulmonary complications postoperatively. Studies have shown that oxygen uptake efficiency slope, oxygen pulse and heart rate at peak exercise are correlated with better postoperative outcome.

Endoscopic Sinus Surgery in Adults With Cystic Fibrosis

To ascertain the effect of endoscopic sinus surgery (ESS) on lung function, intravenous (IV) antibiotic use, and hospitalization in adults with cystic fibrosis (CF). Retrospective analysis. Tertiary care center. Fifteen adults with a diagnosis of CF undergoing ESS between March 1, 2006, and June 31, 2008. Twelve-month preoperative and 12-month postoperative pulmonary function testing (forced vital capacity [FVC] and forced expired volume in 1 second [FEV1]), number of IV antibiotic courses, total number of days of intravenous antibiotic use, and number of inpatient hospital days (IHDs) were assessed. Twenty-two adults with CF underwent ESS; 15 patients had adequate data for evaluation. No significant differences were found between mean preoperative and postoperative FEV1 (61.3% vs 59.5%; P = .41) or FVC (76.4% vs 76.1%; P = .97) or between best preoperative and postoperative FEV1 (67.4% vs 67.0%; P = .95) or FVC (84.2% vs 83.0%; P = .86) (paired samples t test). The number of IV antibiotic courses and the total number of days of IV antibiotic use did not differ between the preoperative and postoperative periods (Wilcoxon signed rank test P = .61 and P = .10, respectively). However, the number of IHDs was significantly lower in the 1-year postoperative period (36.7 days) vs the 1-year preoperative period (59.1 days) (Wilcoxon signed rank test, z = -2.20, P = .03). This preliminary study of ESS in adult CF patients indicates significant reduction in the number of IHDs in the postoperative period. However, there is no evidence that ESS improved lung function or the need for IV antibiotics.

The impact on quality of life after en‐bloc resection for non‐small‐cell lung cancer involving the chest wall

En-bloc resection for non-small cell lung cancer with chest-wall involvement may achieve a 5-year survival rate higher than 40%, but the impact on postoperative quality of life is not yet known. Twenty-six patients undergoing en-bloc lung resections were included. Life quality ratings were assessed through a Short-Form 36 questionnaire preoperatively and at six, 12, 18 and 24 month follow-up visits. The degree of dyspnea, pain level, and flow-volume curves were also obtained at the same time periods. Changes occurring over time were analyzed by means of repeated-measure ANOVA. As a whole, the Physical Component Summary score declined six months postoperatively (P < 0.0001) and failed to improve thereafter. Patients with preoperative Forced Expiratory Volume in one second (FEV1 ), <80% predicted (P = 0.029), resected ribs >2 (P = 0.03), and chest wall defect ≥50 cm2 (P = 0.007) experienced a greater and lasting impairment. Net postoperative decrease in FVC (P = 0.02; r = 0.48) and dyspnea worsening (P = 0.03; r =-043 at six months, P = 0.05; r =-0.39 at 12 months) were also correlated with the extent of physical deterioration, whereas age (P = 0.92), gender (P = 0.51), type of resection (P = 0.71), and adjuvant therapy (P = 0.68) did not. The Physical Component Summary didn't change significantly in patients with high pain levels (VAS >7). The Mental Component Summary score increased slightly at six months, with no difference in any patients' subgroup. The extent of chest wall resection, preoperative FEV1 , and postoperative decline in FVC were the main indicators of quality of life impairment after en-bloc resection for lung cancer. The impact upon quality of life should be considered in a cost-to-benefit ratio of planning this surgery in suboptimal candidates.

Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection

BackgroundAnatomic sublobar resection is being assessed as a substitute to lobectomy for primary lung cancers. However, persistent air leak after anatomic sublobar resection is prevalent and increasing surgical morbidity and costs. The use of electrocautery is being popularized recently in anatomic sublobar resection. We have retrospectively evaluated the safety and efficacy of intersegmental plane dissection using electrocautery.MethodsBetween April 2009 to September 2010, 47 patients were treated with segmentectomy for clinical T1N0M0 non-small cell lung cancers. The intersegmental plane was dissected using electrocautery alone or in combination with staplers. We evaluated the methods of dividing intersegmental plane (electrocautery alone or combination with electrocautery and staplers), intraoperative blood loss, duration of chest tube placement, duration of surgery, preoperative FEV1.0 %, incidence of prolonged air leak, length of postoperative hospital stay, postoperative pulmonary function at 6 months after surgery and the cost for sealing intersegmental plane.ResultsAmong the 47 patients, 22 patients underwent intersegmental plane dissection with electrocautery alone and 25 patients did in combination with electrocautery and staplers. The mean number of stapler cartridges used was only 1.3 in electrocautery and staplers group. Mean age, gender, number of patients whose FEV1% < 70 % were similar between two groups. There was no statistical difference between electrocautery alone and combination with electrocautery and staplers group in duration of surgery (282 vs. 290 minutes), intraoperative blood loss (203 vs.151 ml), duration of chest tube placement (3.2 vs. 3.1 days), postoperative hospital stay (11.0 vs.10.0 days), postoperative loss of FEV1.0 (13 vs.8 %), loss of FVC (11 vs. 6 %) or incidence of minor postoperative complications [9 % (2/22) vs. 16 % (4/25), p = 0.30)]. However, incidence of prolonged air leak was higher in electrocautery alone group than in combination with electrocautery and staplers group [14 % (3/22) vs. 4 % (1/25), p = 0.025)]. The cost of materials for sealing air leaks amounted to €964 per patient in the electrocautery alone group and €1594 per patient in combination with electrocautery and staplers group.ConclusionsThe number of patients with prolonged air leak was higher in the electrocautery alone group. The use of staplers in addition to electrocautery may lead to reduced prolonged air leak. However, the use of electrocautery for intersegmental plane dissection appeared to be safe with acceptable postoperative complications and effective in reducing costs.

Role of adjuvant chemotherapy after pneumonectomy for non-small cell lung cancer

Adjuvant chemotherapy is used as an alternative treatment for non-small cell lung cancer (NSCLC); however, the efficiency of post-pneumonectomy adjuvant chemotherapy in NSCLC has not been clarified. In the present study, patients who benefited from adjuvant chemotherapy with TP/NP/GP were identified. A total of 217 patients who underwent pneumonectomy were identified in this study. Of these, 87 underwent pneumonectomy combined with adjuvant chemotherapy (TP/NP/GP regimen) and 130 underwent pneumonectomy only in the initial management. The primary endpoint of the present study was overall survival. Actuarial survival analysis was conducted using the Kaplan-Meier method. Postoperative adjuvant chemotherapy significantly improved the survival rate of patients who underwent left pneumonectomy and in patients with a preoperative forced expiratory volume in 1 sec (FEV1) greater than or equal to 21. Age had no effect on the survival rate of patients with or without postoperative adjuvant therapy. Post-pneumonectomy adjuvant chemotherapy is an efficient therapy in NSCLC for patients with preoperative FEV1 greater than or equal to 21 or who received left pneumonectomy.

AccuO2Oximetry-Driven Oxygen-Conserving Device Versus Fixed-Dose Oxygen Devices in Stable COPD Patients

In patients being considered for lung-resection surgery, quantitative perfusion scintigraphy is used to predict postoperative lung function and guide the determination of lung-resection candidacy. Vibration-response imaging has been proposed as a noninvasive, radiation-free, and simpler method to predict postoperative lung function. We compared vibration-response imaging to quantitative perfusion scintigraphy for predicting postoperative FEV(1) and diffusing capacity of the lung for carbon monoxide (D(LCO)). We enrolled 35 candidates for lung resection. Twenty-five patients had preoperative FEV(1) and D(LCO) MEASUREMENTS: The vibration-response-imaging measurements showed strong correlation with the quantitative-perfusion-scintigraphy measurements of predicted postoperative FEV(1)% (r = 0.87, P < .001), predicted postoperative FEV(1) (r = 0.90, P < .001), and predicted postoperative D(LCO)% (r = 0.90, P < .001). There was a correlation between predicted postoperative FEV(1) (% and L) measured via quantitative perfusion scintigraphy and the actual postoperative FEV(1) (% and L) (r = 0.47, P = .048, r = 0.73, P < .001). There was no difference between the vibration-response-imaging measurements and the actual postoperative measurements of predicted postoperative FEV(1) (% and L). There was a correlation between predicted postoperative FEV(1) (% and L) measured via vibration-response imaging and actual postoperative FEV(1) (% and L) (r = 0.52, P = .044, r = 0.79, P < .001). The mean differences between the predicted and actual postoperative FEV(1) values were 49 mL with vibration-response imaging, versus 230 mL with quantitative perfusion scintigraphy. Neither the vibration-response imaging nor the quantitative perfusion scintigraphy predicted postoperative D(LCO)% values agreed with the actual postoperative D(LCO)% values. Vibration-response imaging may be a good alternative to quantitative perfusion scintigraphy in evaluating lung-resection candidacy.